Wallace Physician Services LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

35-076674 Issued in OH

Legal business name

WALLACE PHYSICIAN SERVICES LLC

Practice address

1577 Goodman Ave Ste a
Cincinnati, OH 45224-1044

Phone

(513) 403-3762

Fax

(513) 521-6403

NPI assigned

Feb 15, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Waymon L Wallace, M.D.NPI 1841213667

Title

President

Phone

(513) 674-9601

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Waymon L Wallace, MD

  • Internal Medicine Physician
  • Cincinnati, OH
  • NPI 1841213667
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1297728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1144527870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40535",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452400535",
            "telephone_number": "859-384-9045",
            "fax_number": "859-212-0949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1577 GOODMAN AVE STE A",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452241044",
            "telephone_number": "513-403-3762",
            "fax_number": "513-521-6403"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11414 Odessa Ct",
            "address_purpose": "LOCATION",
            "city": "Cincinnati",
            "state": "OH",
            "postal_code": "452402847",
            "country_code": "US",
            "telephone_number": "859-384-9045",
            "fax_number": "859-212-0949",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WALLACE PHYSICIAN SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-15",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "WAYMON",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "513-674-9601",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35-076674",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madison Wall
• Quinton Wall
• Sheila Wall, MD
• Shelby Wall
• Wallace Family Dentistry LLC
• Alex Wallace, MA, LMHC, LPCC
• Alexandria Wallace
• Allison Wallace, MSW, MFT
• Anne M. Wallace, PH.D.
• Brandon Tobias Wallace, DMD

• Internal Medicine Physician in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• Internal Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.